TN 71 (12-22)

HI 00805.383 Exceptional Conditions Special Enrollment Period (SEP) for Individuals Impacted by an Emergency or Disaster Declared by Federal, State or Local Government Entities

 

A. Introduction

Medicare entitlement and enrollment decisions may be transmitted through letters delivered by the U.S. Postal Service. Beneficiaries may elect to enroll in premium Part A and/or Part B by mailing their enrollment decision to SSA.

The severity and duration of extreme weather-related events and other emergencies can be difficult to accurately predict, but may strip individuals of their ability to carry out day-to-day activities. These events can result in disruptions in mail delivery, field office closures due to disruptions in electricity or phone access, and operational delays, any of which can prevent individuals from submitting their enrollment application in a timely manner.

B. Eligibility

An SEP is available to those who were not able to enroll in premium Part A, Part B, or both due to a weather-related event or other emergency that began January 1, 2023, or later.

Eligible individuals are those who:

  • During a weather-related emergency or disaster, were in an enrollment period, and

  • Either the individual, the individual’s representative payee, legal guardian or person providing care, resided in areas for which a Federal, state, or local government entity declared a disaster or other emergency.

NOTE: The person must have missed an enrollment period because of an emergency or disaster declared by Federal, state or local government entities. For individuals who missed an enrollment period because of an emergency or disaster outside the U.S. and its territories, please refer to HI 00805.387 Exceptional Conditions Special Enrollment Period (SEP) for Other Exceptional Conditions.

C. Proof

  1. 1. 

    Technicians may obtain proof of a disaster declaration:

    • directly from the individual, or

    • by verifying other websites or sources, such as:

      • the Federal Emergency Management Agency’s website, https://www.fema.gov/disaster/declarations, to view the declared disasters;

      • the state’s official website where you can view the declaration;

      • other local government website or paper version of the declaration; and

      • SSA’s Emergency Messages (EM), Administrative Messages (AM), Operational Bulletins (OB) instructions that state that a disaster or emergency was invoked.

  2. 2. 

    Technicians must obtain proof of residence that displays a recent date that proves residency in the affected area.

NOTE: Proof of residence is also applicable to the individual’s representative payee, legal guardian or person providing care.

Examples of primary proof of residence can include but are not limited to:

  • medical records,

  • title or deed to real estate,

  • rent receipts or rental lease,

  • unemployment records,

  • utility bills,

  • state driver’s license or ID,

  • mail addressed to the claimant at an address in the affected area,

  • telephone directory listing,

  • tax assessment notice,

  • marriage certificate,

  • divorce decree(s),

  • summer camp or campground registration,

  • fishing, hunting, or boating license purchased in the affected area,

  • birth certificate of the claimant’s child,

  • school records,

  • records that show participation in a social program,

  • local bank record or check-cashing card,

  • record of volunteer activity, and

  • religious, fraternal, or social organization records.

NOTE: If primary evidence is not available, refer to section D of HI 00803.040 for ways to develop for secondary evidence.

D. Duration

The SEP begins the earlier of:

  • the date an emergency or disaster is declared, or

  • the start date identified in the declaration.

The SEP ends at the end of the month six months after the end date which is the later of:

  • the date identified in the disaster or emergency declaration, or

  • the end date of any extensions or the date when the declaration has been determined to have ended or has been revoked, or

  • the date of the declaration, if such date is after the end of the disaster.

Example: A natural disaster occurs and the individual’s state declares it as such on March 1, 2023. The emergency declaration ends on June 25, 2023. Therefore, the SEP begins on March 1, 2023 and ends on December 31, 2023.

E. Calculation of premium surcharge

There will be no late enrollment penalty (LEP) if enrolled pursuant to this SEP.

F. Effective date

The individual’s coverage begins the first day of the month following the month of enrollment.

G. Processing instructions

See HI 00805.277 for processing instructions.

H. Reference

HI 00805.277 Processing SEP Enrollments


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805383
HI 00805.383 - Exceptional Conditions Special Enrollment Period (SEP) for Individuals Impacted by an Emergency or Disaster Declared by Federal, State or Local Government Entities - 12/21/2022
Batch run: 12/21/2022
Rev:12/21/2022